Child road trauma poses a preventable public health burden to the community. This PhD research aimed to: 1) quantify the magnitude of child passenger injuries in New South Wales (NSW), Australia; 2) evaluate the effectiveness of different restraint use to prevent fatalities among child passengers; and 3) estimate the benefit in the general child population from different intervention targets relating to restraint use. It comprised two studies to validate methodology and four independent epidemiological studies. The first study to validate methodology assessed the data item availability and categorization across different road traffic injury surveillance data collections in NSW in relation to World Health Organization recommended data item lists and necessary data item lists for road traffic injury research. Exclusion of, or insufficient categorization of, crucial data items such as restraint use and injurious outcome existed for each data collection. The other study to validate methodology assessed the performance (in terms of incidence estimates, sensitivity, and specificity) of several methods for removing multiple counting when conducting analyses on hospital separation data for child passenger injuries under either primary-diagnosis or all-diagnoses based injury definition, using linkage methods as a comparison. The "readmission"-based criterion consistently best approximated the linkage-method-derived incidence rate. Two epidemiological studies used NSW hospital separation datasets and quantified the magnitude of child road trauma in NSW in terms of hospitalisation rates. One study examined the trend in hospitalised injury incidence rates during the period of July 1998 to June 2005 using a non-parametric estimation method, and reported a non-significant decline of hospitalised injuries to child passengers over time. The second study used Poisson regression to demonstrate that rural NSW children were two times more likely to suffer hospitalised injuries compared with their urban counterparts. The third epidemiological study used the Fatality Analysis Reporting Systems (FARS) from the United States (US) and estimated the association between different restraint uses and child passenger fatality using a matched cohort method. Improperly using restraints significantly elevated the risk of death for child passengers involved in a crash compared to any other restraint use. The advantage of child restraints over seat belts in terms of fatality reduction was not statistically significant, although previous studies have shown an advantage for serious injury reduction. The last study was performed to quantify the relative public health benefit in terms of reduction in child passenger deaths and injuries for different interventions relating to restraint use in the general population using a case-based population attributable risk fraction method. Results support the ongoing child restraint legislation change in Australia to require compulsory child restraint uses for children up to their 7th birthday, and an increasing proper use of age-appropriate restraints would provide the greatest reduction in fatalities and injuries among child passengers assuming equal population uptake for all interventions. In conclusion, this thesis demonstrates that child road trauma remains a public health burden to the Australian community; and highlights the importance of properly using age-appropriate restraints in preventing injuries to child passengers.
| Identifer | oai:union.ndltd.org:ADTP/258170 |
| Date | January 2008 |
| Creators | Du, Wei, Public Health & Community Medicine, Faculty of Medicine, UNSW |
| Publisher | Publisher:University of New South Wales. Public Health & Community Medicine |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | http://unsworks.unsw.edu.au/copyright, http://unsworks.unsw.edu.au/copyright |
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